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The Tip of the Iceberg

Jerry H. Gurwitz, MD

JAMA. 1994;272(4):316-317.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

The problem of inappropriate prescribing of medications to older patients is widely acknowledged and has been publicized by professional societies, governmental organizations, advocacy groups for the elderly, and the media. However, the true magnitude of the problem remains unclear. Although the use of antipsychotic medications in the nursing home setting has come under considerable scrutiny,¹ it is generally recognized that suboptimal prescribing to the elderly extends well beyond excessive prescribing of this single drug category. Yet, to date, information regarding the quality of drug prescribing to geriatric patients in other clinical settings has been extremely limited, and claims about suboptimal prescribing have been based more on anecdote and conjecture than on actual data. Which pharmacotherapeutic domains comprise the most serious problem areas and how frequently inappropriate prescribing actually occurs are just some of the questions that need to be more fully answered to develop strategies to improve the quality . . . [Full Text PDF of this Article]

Author Affiliations
From the Program for the Analysis of Clinical Strategies, Gerontology Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass, and the Brockton/West Roxbury Veterans Affairs Medical Center, West Roxbury, Mass.

Footnotes
Reprint requests to the Program for the Analysis of Clinical Strategies, Brigham and Women's Hospital, 221 Longwood Ave, Suite 309, Boston, MA 02115 (Dr Gurwitz).

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